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Adalimumab was discontinued, and patient was treated with evidence-based oral disease-modifying HF therapy; 2 months later, cardiac function has returned to normal. This case clearly demonstrated the acute onset of decompensated heart failure with adalimumab usage.
Inhibitors of tumor necrosis factor TNF -alpha adalimumab offer an important targeted therapy in a large number of inflammatory conditions, including rheumatoid arthritis RA , psoriasis, spondyloarthritis and inflammatory bowel disease IBD [7,8].
In fact, the effectiveness of those drugs has been well established. However, multiple adverse effects have been identified through both clinical trials and post-marketing surveillance, ranging from benign to serious side effect such as lymphomas, infections especially reactivation of latent tuberculosis , demyelinating disease and cardiomyopathy which are associated with substantial mortality [9,10]. A year-old woman, former smoker, non-alcoholic has been diagnosed with Crohn's disease since teenage, maintained on azathioprine.
Apart from her gastro-intestinal symptoms, her prior medical history was unremarkable. She was admitted to our ward for profuse watery diarrhea with abdominal pain, managed as acute exacerbation of her Crohn's disease. At that time adalimumab mg was initiated and she had improved a lot from her baseline.
Two weeks later, she received a dose of 80 mg subcutaneous injection according to the universal treatment regimen of adalimumab, then after 8 days, she presented to our ER department with severe shortness of breath, palpitation, cough, and desaturation.
Coronary angiography was made showing non stenotic coronaries Figure 1. Taking into consideration the last echocardiography performed 1 month ago which was totally normal in addition to non-specific MRI features obtained, as an exclusion diagnosis, adalimumab was considered as the cause of the acute decompensated heart failure.
Patient was placed on optimal heart failure therapy then discharged after appropriate stabilization. Adalimumab remained certainly withdrawn then 2 months later, repeated echocardiography demonstrated a full recovery. Common side effects such as headache, rash and nausea are usually well tolerated and self-limiting and generally do not lead to drug discontinuation.
However, disabling and potentially life-threatening side effects occurred as well, particularly opportunistic infection, tumor development, and cardiotoxicity. Other common side effects such as headache, sinus congestion, nausea, and flu or cold symptoms are also brief and can be treated with over-the-counter medications and rest. However, more serious side effects, such as liver problems, infections, and blood problems will take weeks or months to develop and may continue to worsen as long as Humira is taken.
Severe infections, cancer, liver failure, heart problems, and auto-antibodies may have long-term or life-long consequences even after Humira is discontinued.
Regular office visits and tests are necessary to monitor the longer-term effects of Humira. Humira is not always the right medication for everyone. People with infections, latent infections, exposure to tuberculosis, a history of cancer, congestive heart failure, nerve disorders such as multiple sclerosis, liver disease, or allergies to the drug or any of its ingredients may not be suitable candidates for taking Humira.
Humira contains a black-box warning for serious infections. Humira will be discontinued if a serious infection, sepsis, or invasive fungal infection develops while taking the drug. Patients will need to be tested for tuberculosis before and during treatment with Humira. Any patient who tests positive for latent tuberculosis will require TB treatment before receiving Humira.
The drug will be discontinued if a patient develops TB during treatment. Patients at risk for hepatitis B or histoplasmosis infections will also be tested before receiving Humira. Again, the drug will be discontinued if injections reactivate a latent hepatitis B infection. Humira and other TNF blockers contain a black-box warning for malignancies, particularly lymphoma.
Patients who have been treated for any cancer other than non-melanoma skin cancer may not be suitable candidates for treatment with Humira or similar TNF blockers. If a malignancy develops during treatment, Humira may be discontinued. Patients with demyelinating disorders such as multiple sclerosis, Guillain-Barre syndrome, peripheral demyelinating disease, or optic neuritis may not be suitable candidates for Humira therapy.
Demyelinating diseases are progressive nerve disorders that slowly strip away the protective sheath around nerve branches, decreasing their ability to pass nerve signals. Humira can cause flare-ups of any of these disorders, so Humira therapy will require constant monitoring in these patients.
Humira can worsen congestive heart failure, so patients with congestive heart failure will need to be monitored closely when taking Humira. Patients with allergies to the drug, any of its ingredients, or rubber and latex may not be suitable candidates for Humira. The drug will be discontinued at any sign of a severe allergic reaction. Clinical data suggests that the relative risk of major birth defects is no higher in women treated with Humira versus those who are not.
As a protein, Humira does pass through the placenta to the fetus. Few antibodies pass into the fetus during the first trimester, but the passage of antibodies steadily increases until it maximizes in the third trimester.
This may be a sign of skin cancer caused by Humira. You should also call your doctor if you develop lymphoma symptoms or possible symptoms of other cancers, such as:.
As with most drugs, Humira can cause an allergic reaction in some people. Symptoms can be mild or serious and can include:. For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Humira.
This drug has boxed warnings about serious infections and cancer. Be sure to talk with your doctor about your health history before you take Humira. This drug may not be right for you if you have certain medical conditions or other factors that affect your health.
Conditions and factors to consider include:. Active infection. Your doctor may want to treat your infection before you take Humira. Make sure to tell your doctor about all conditions you have, including any infections, before starting Humira treatment. Heart failure. Humira belongs to a group of drugs called tumor necrosis factor TNF blockers.
This type of drug has been reported to cause heart failure or make existing heart failure worse. Liver damage. If you have a history of liver damage or liver disease, make sure to discuss this with your doctor before starting Humira.
Nervous system problems, such as multiple sclerosis MS. Humira can make symptoms of nervous system problems and demyelinating diseases worse. Examples of these types of conditions include MS and seizures.
If you have a nervous system problem, be sure to talk with your doctor about whether Humira is the best choice for you.
Hepatitis B. You may continue to have these tests while you take Humira, and for several months after your last dose if you stop taking the drug. Humira can cause cancer, or can cause existing cancerous tumors to get worse. If you have cancer, talk with your doctor before you begin taking Humira.
Recent vaccination. Live vaccines contain a small amount of a weakened live virus or bacteria. Latex allergy or allergic reaction. Some Humira products come with a needle cover that could contain natural rubber latex. If you have a latex allergy , talk with your doctor about other treatments or other forms of Humira that may be better choices for you. But drinking alcohol may worsen some of the conditions Humira is used to treat.
In people who have taken the drug while breastfeeding, no side effects have been reported. If you have questions about taking Humira while pregnant or breastfeeding, talk with your doctor.
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